Provider Demographics
NPI:1336332634
Name:BRENNAN, MARYANN B (OTR)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:B
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SUNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-2400
Mailing Address - Country:US
Mailing Address - Phone:610-639-1814
Mailing Address - Fax:
Practice Address - Street 1:1115 SUNRIDGE DR
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-2400
Practice Address - Country:US
Practice Address - Phone:610-639-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15346225XP0200X
PAOC003300L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15346OtherOT LICENSE
PA0019333280002Medicaid